Effects of different dual-task trainings on gait and cortical activation during obstacle crossing in stroke patients: a randomized controlled trial.

OBJECTIVE

After stroke, patients often exhibit abnormal gait and cortical activation patterns during obstacle crossing, which heightens their risk of falls. This study aimed to examine the effects of Motor dual-task gait training (MDTG) and cognitive dual-task gait training (CDTG) on gait and cortical activation during obstacle crossing in stroke patients, to clarify their differential effects and underlying neural mechanisms.

METHODS

35 stroke patients were recruited and randomly assigned to either the MDTG group (n = 17) or the CDTG group (n = 18), and were assigned to receive the corresponding intervention training. Participants in both groups underwent a 4 week training program, consisting of three sessions per week. Spatio-temporal parameters, lower limb joint angles and moments, and changes in oxyhemoglobin concentrations (ΔHbO2) were assessed in patients during obstacle crossing both pre- and post-training.

RESULTS

Following training, both groups demonstrated significant improvements in stride length, step length, step width, gait speed, toe-obstacle clearance of the leading and trailing limb, toe-obstacle distance of the trailing limb, anteroposterior and mediolateral COM displacement, mediolateral COM mean velocity, anteroposterior COM-COP distance, hip flexion angle of the leading limb, knee flexion angle of the trailing limb, and peak hip flexion moment of the trailing limb (P < 0.05). Concurrently, following the training, ΔHbO2 in the bilateral prefrontal cortex was significantly reduced during obstacle crossing (P < 0.05). However, no significant differences were observed between the two groups for any parameters (P>0.05).

CONCLUSION

A 4-week program of either MDTG or CDTG effectively improved postural stability, enhanced control of the swing limb and COM, and increased efficiency in cortical resource utilization during obstacle crossing in stroke patients. However, no differences in these effects were observed between the two training modalities.

CLINICAL TRIAL REGISTRATION: https://www.chictr.org.cn/showproj.html?proj=200755, identifier ChiCTR2300077304.